Provider Demographics
NPI:1104303544
Name:MCCALLIE, MARCA (PHD, PSY)
Entity type:Individual
Prefix:
First Name:MARCA
Middle Name:
Last Name:MCCALLIE
Suffix:
Gender:
Credentials:PHD, PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E ROUTE 66 STE 203
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5777
Mailing Address - Country:US
Mailing Address - Phone:928-606-2907
Mailing Address - Fax:
Practice Address - Street 1:16 E ROUTE 66 STE 203
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5777
Practice Address - Country:US
Practice Address - Phone:928-606-2907
Practice Address - Fax:928-864-5024
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005968103T00000X
AZPSY-005968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist